tbuckley/cabot-search huggingface dataset:
Abstract P304: Association of Epigenetic Age Acceleration With Cognition in the Bogalusa Heart Study
Authors: Zhijie Huang, Lydia A Bazzano, Xiao Sun, Ruiyuan Zhang, Varun Rao, Mengyao Shi, Owen Carmichael, Yang pan, Xi Cao, Yizhuo Liu, Wei Chen, Jiang He, Changwei Li, Tanika N Kelly
Journal: Circulation (2023)

Background: Despite known associations of epigenetic age acceleration (EAA), or increased DNA methylation (DNAm)-based age relative to chronological age, with Alzheimer’s disease, few studies have investigated the relation of EAA with midlife cognitive function. We examined cross-sectional associations of EAA with cognition among the 1,252 middle-aged participants of the Bogalusa Heart Study 2013-2016 study visit. Methods: Whole-blood DNA methylation data was generated using the Illumina HumanMethylation450 BeadChip. Four EAA measures, including extrinsic EAA (EEAA), intrinsic EAA (IEAA), PhenoAA and GrimAA, were derived from the methylation data. Cognitive function was assessed by a standard battery of eight neurocognitive tests covering five cognition domains, and a global cognition score was calculated. Associations of EAA measures with cognitive function were assessed by 3 multivariable models sequentially adding (i) demographics (age, sex, race, education) and vocabulary; (ii) lifestyle behaviors (smoking, alcohol drinking, and depression), and (iii) clinical measures (blood pressure, lipids, body mass index, glycated hemoglobin, medication, and white blood cell count. Results: After Bonferroni correction (α=1.39E-3), PhenoAA and GrimAA were significantly associated with decreased processing speed (lower Digit coding test score) and decreased working memory (higher trail making test A score). GrimAA was also associated with lower global cognition score ( Table ). EEAA was associated with decreased processing speed (lower Digit coding test). After adjusting for lifestyle and clinical measures, such associations were slightly attenuated but remained at least nominally significant. IEAA was not associated with any cognitive test results. Conclusions: EAA measured by PhenoAA, GrimAA, and EEAA were significantly associated with decreased processing speed, working memory, and/or global cognition. The associations were independent of known cognitive decline risk factors.
Abstract P614: The Association Between Dietary Patterns and Coronary Artery Calcium Score: A Systematic Review
Authors: Bridget M Hussain, Hope Lappen, Andrea Deierlein, Sameera Talegawkar, Niyati Parekh
Journal: Circulation (2023)

Background and Objective: Coronary artery calcium (CAC) score is an early indicator of CVD. Diet is an established primary prevention strategy for CVD, but limited research has systematically evaluated the relationship between diet and CAC. The current study sought to review longitudinal studies evaluating the association between dietary intake and CAC score. Methods: Five databases were searched from inception to October 2022. We included prospective studies that included terms to capture food, diet, and nutrient intake in disease-free adults with CAC score measured by computed tomography. Two authors developed the search strategies and screened articles for inclusion. Results: Of 58 articles on dietary intake and CAC score, nine assessed the relationship between dietary intake at baseline and CAC score at follow up. Sample size was moderate to large across the nine studies, ranging from 861 to 15,368 participants. Seven studies used a food frequency questionnaire, one used a semi-quantitative interview, and one used a single-item question to assess diet intake. One study was conducted in Germany, while eight were conducted in the US. Three studies derived data from the CARDIA study, a cohort of young adults aged 18-30 at baseline. Two studies used the MESA study, a prospective study of adults aged 45-84 at baseline. Four studies found an association between dietary pattern intake and CAC score, with studies finding that higher fruit and vegetable intake and Mediterranean-like diet associated with lower risk of CAC progression, and low carbohydrate diet and starchy vegetable, meat and alcohol intake associated with increased risk of CAC presence. Conclusions: Studies suggested that there is a relationship between diet intake and CAC presence and progression, with research reflecting positive effects associated with patterns rich in fruits and vegetables alongside deleterious effects associated with high saturated fat and low dietary fiber intake. Finding reflect the strong influence of diet on clinical indicators of CVD.
Abstract P544: Post-COVID-19: Predictors of Pulmonary Fibrosis
Authors: Cristina P Baena, Ariele Barreto Haagsma, Maria Fernanda Vieira, Maria Letícia Tebet, Rebecca Stival
Journal: Circulation (2023)

Introduction: From observational studies, it is known that some survivors of COVID-19 pneumonia have developed fibrotic pulmonary remodeling, restrictive lung abnormalities, associated with impaired exercise tolerance and poor quality of life at follow-up. Post-COVID-19 pulmonary fibrosis may be defined as the presence of persistent fibrotic changes identified on follow-up CT scans, such as traction bronchiectasis. It is important to identify the potential risk factors for the occurrence of pulmonary fibrosis in this context, although they have not yet been completely defined. Hypothesis: We hypothesize that lung fibrosis may be also a possible long-term consequence of COVID-19 pneumonia and the risk factors associated with the acute phase that enhance the risk of pulmonary sequelae, such as duration of hospitalization and intensive care stay, of high-flow oxygen support, and need for mechanical ventilation. Methods: We undertook a cohort study of COVID-19 survivors, that required supplemental oxygenation during the acute phase, who had been discharged from hospitals April 2020 to March 2022 in public hospitals of Curitiba/PR (BRAZIL). At 1-month and 6-month follow-up visit, survivors were interviewed with questionnaires symptoms, received a physical examination, sit-to-stand test, laboratory test ant chest CT scan was performed between two visits. The primary outcomes were persistent fibrotic changes, such as traction bronchiectasis, on follow-up chest CT. Multivariable adjusted logistic regression models were used to evaluate the risk factors of CT scan outcomes. Results: We followed 63 COVID-19 survivors with CT scan follow-up. The median age of patients was 52 years (±13.3) and 37 (58.7%) were women. The median CT scan follow-up time was 151 days (38-428). The median hospitalization time during acute phase was 13 (3-48) days. The proportion of patients with persistent dyspnoea, characterized by mMRC score of 1 or more, was 52 (82,5%). The proportion of patients with at least one fibrotic change on CT scan was 35 (55.6%), traction bronchiectasis was identified on 16 (25.4%). Hospitalization time during acute phase was associated with traction bronchiectasis, main persistent fibrotic change on CT scan (OR, 1.19; 95% CI:1.036, 1.207; p=0,004). Conclusion: In a follow-up, the duration of hospitalization COVID-19 acute phase was associated with higher odds of traction bronchiectasis on chest CT follow-up.
Abstract 64: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures, Individually and as a Mixture, Are Associated With Obesity Risk at 16-20 Years in the Project Viva Prospective Cohort: Implications for PFAS as Hazardous Substances for Developmental Health
Authors: Mingyu Zhang, Sheryl L Rifas-Shiman, Izzuddin Aris, Abby Fleisch, Emily Oken, Marie-France Hivert
Journal: Circulation (2023)

Introduction: PFAS are obesogenic in adults, but findings on the associations between prenatal PFAS exposures and child obesity risk are inconsistent, and it is not clear if such associations extend up to mid- to late adolescence. We investigated the individual and joint associations of prenatal PFAS exposures with obesity risk at 16-20 years. Methods: In the prospective pre-birth cohort Project Viva, we measured PFAS in maternal plasma samples collected in the first trimester and child body mass index (BMI) at the mid-adolescent visit (median: 17.4y; range: 15.9-20.0y). We defined obesity as BMI ≥ 95 th percentile for age and sex based on the CDC Growth Charts. We used Poisson regression with robust variance estimates to examine associations of each PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with obesity. We adjusted for maternal age, education, pre-pregnancy BMI, race/ethnicity, parity, and smoking status during pregnancy. Results: Among 545 participants, 73 (13%) had a BMI in the obese range. Children with higher prenatal PFOS and PFNA exposures had a greater risk of obesity [relative risk = 1.59 (95% CI: 1.19, 2.11) per doubling of PFOS and 1.48 (95% CI: 1.11, 1.98) per doubling of PFNA] in multivariable-adjusted models. In BKMR models, PFOS and PFNA were similarly associated with greater risk of obesity when accounting for co-exposures of other PFAS (Panel A) . There was an interaction between PFOS and PFOA: the positive association between PFOS and obesity was stronger when PFOA levels were lower (Panel B) , while there was a negative association between PFOA and obesity when PFOS levels were higher (Panel C) . Children with higher concentrations of the mixture PFAS had greater obesity risk in a dose-dependent fashion (Panel D) . Conclusions: Prenatal PFAS exposures may have long-lasting, intergenerational obesogenic effects. Our findings support the U.S. Environmental Protection Agency’s recent designation of PFAS as hazardous substances for human health, including developmental health.
Abstract P473: Early Onset Stroke in the Black Women's Health Study
Authors: Hugo J Aparicio, Yvette Cozier, Nora Xu, Vasileios Lioutas, Julie G Shulman, Julie R Palmer, Lynn Rosenberg, Shanshan Sheehy
Journal: Circulation (2023)

Background: The impact of stroke in young adulthood and mid-life is disproportionately large due to greater disability-adjusted life-years lost and worsened quality of life. There is evidence that stroke incidence has increased among young adults in recent decades, although there is conflicting data, especially among subgroups defined by sex and race. We investigated incidence of early-onset stroke among U.S. Black women. Methods: The Black Women’s Health Study is a prospective study of 59,000 Black women from across the U.S. who have been followed since 1995 (aged 21-69 years, median age of 38 years). Both ischemic and hemorrhagic stroke were ascertained by self-report at biennial health questionnaires through December 31, 2019. Stroke mortality was determined through the National Death Index. We stratified by age group: ages 35-54 and ages 55 and older, to distinguish early onset stroke and stroke occurring in later life. We examined crude incidence rates of total stroke cases (per 1000 person-years) during two sequential 12-year follow up periods, 1995-2007 and 2007-2019. Stroke incidence rates were calculated and modeled with Poisson regression. Results: Incident stroke or stroke death occurred in 2093/58,386 participants (3.58%) during 1,316,545 person-years of follow-up from 1995 to 2019. Among women aged 35-54 years the incidence rate was 1.59 (95% CI 1.46-1.72) in the 1995-2007 period (564 cases/355,601 person-years) and 1.12 (95% CI 1.02-1.23) in the 2007-2019 period (460 cases/409,870 person-years). For participants aged 55 or older the incidence rate was 4.19 (95% CI 3.69-4.73) in the 1995-2007 period (257 cases/61,357 person-years) and 2.83 (95% CI 2.62-3.05) in the 2007-2019 period (678 cases/239,433 person-years). Conclusion: In this preliminary analysis, stroke incidence in Black women decreased across study time periods, from 1995-2019, most clearly among participants aged 55 years or older. These findings are similar to those observed in other population-based cohorts reporting incidence rates among Black Americans, for example in the Atherosclerosis Risk in Communities Study. Black women continue to be a high-risk subgroup for stroke and should be a focus for preventive public health efforts, from as early as young adulthood.
Abstract P250: Prospective Associations of Coping Strategies and Variability in Their Use With Hypertension and Obesity Incidence
Authors: Shuqi Zhang, Laura Kubzansky, Karestan Koenen, Judith Moskowitz, Janet Rich-edwards, Claudia Trudel-Fitzgerald
Journal: Circulation (2023)

Objectives: Stressful adverse experiences (e.g., childhood abuse) are associated to greater cardiometabolic disease risk. Yet, it is unknown whether how individuals cope with these stressors can influence disease risk. Coping strategies are usually characterized as being either adaptive (e.g., seeking social support) or maladaptive (e.g., denying the stressor). However, flexibility in tailoring their implementation to contexts appears critical to optimal adjustment and might matter for cardiometabolic health as well. Method: Participants free of hypertension and obesity from the Nurses’ Health Study II completed the validated COPE inventory and reported relevant potential covariates in 2001 (N=32,762). Hypertension and obesity respective incidence were documented every two years until 2019, separately. Cox proportional hazard models estimated hazard ratio (HR) and 95% confidence intervals (CI) of hypertension and obesity associated with the use of individual coping strategies (continuous standardized scores). The Between-Strategy Index, validated in prior epidemiologic research, was used to derive a proxy for coping flexibility, which was considered in tertiles (smaller, moderate, greater levels). This score indicates to what extent strategies chosen within a repertory are (un)equally used and potentially indicates attempts to find the best strategy or favor certain strategies across distinct stressors. In all models, a 2-year lag was introduced to reduce concerns of reverse causation. Results: After controlling for baseline sociodemographic and health status (core model), no adaptive or maladaptive strategies were related to a risk of hypertension onset, and only a few adaptive and maladaptive strategies were related to obesity incidence (e.g., per 1-SD increase: Active coping, HR=0.96, 95%CI=0.93, 0.99; Behavioral Disengagement, HR=1.05, 95%CI=1.02, 1.08). When considering coping flexibility, greater levels were related to a marginally significant lower risk of disease (hypertension: HR greater vs. moderate =0.95, 95%CI=0.90, 1.01; obesity: HR greater vs. lower levels =0.93, 95%CI=0.86, 1.00). In secondary analyses, results were overall similar when further adjusting for behavioral factors. Discussion: These findings suggest that how midlife women typically cope with stressors was not clearly associated with incidence of hypertension or obesity, although we cannot rule out a modest association with some individual coping strategies, and a suggestive protective association with greater coping flexibility levels. Since the COPE inventory captures how individuals handle stressors in general, future research on hypertension and obesity incidence should consider stressor-specific measures of coping.
Abstract P541: Trends in Initiation of Anticoagulation for Atrial Fibrillation in the Early Months of the COVID-19 Pandemic
Authors: Lanting Yang, Shangbin Tang, Meiqi He, Jingchuan Guo, Nico Gabriel, Gretchen Swabe, Walid Gellad, Utibe R Essien, Samir Saba, Emelia J Benjamin, Jared W Magnani, Inmaculada Hernandez
Journal: Circulation (2023)

Introduction: Oral anticoagulation (OAC) is the treatment of choice to prevent stroke in patients with atrial fibrillation (AF). We evaluated changes in OAC initiation in newly diagnosed AF after the onset of the COVID-19 pandemic. Hypothesis: We hypothesized that individuals newly diagnosed with AF in the early months of the COVID-19 pandemic would be less likely to initiate OAC than those with incident AF before the pandemic. Methods: We selected individuals with incident AF in 01/01/2016 - 09/30/2021 from Optum’s de-identified Clinformatics® Data Mart Database. AF was defined by having ICD-9 code 427.31 or ICD-10 codes I48.0, I48.1, I48.2, or I48.91 at the first or second diagnosis field. For every 30-day period. We measured the proportion of individuals newly diagnosed with AF initiated OAC within 30 or 180 days of diagnosis. As secondary outcomes, we evaluated the initiation of warfarin and of direct oral anticoagulants (DOACs) individually. We constructed interrupted time series analyses to examine changes in the level and trend of OAC initiation following the onset of the COVID-19 pandemic, defined by the date of the World Health Organization declaration (3/11/2020). Results: The study sample included 573,524 individuals (age 73± 11 years, 48% female sex, 85% Medicare beneficiaries). Although initiation of OAC and DOAC increased in 01/01/2016-09/30/2021 (Figure), there were no significant changes associated with the onset of pandemic (all P&gt;0.05). Rates of warfarin initiation decreased over time, from 9.7% in year 2016 to 1.9% in year 2021. Conclusion: There were no significant changes in the initiation of OAC immediately after the onset of the COVID-19 pandemic among patients newly diagnosed with AF during this time.
Abstract P445: Patterns in Physical Activity Among Individuals With Cardiovascular Risk Factors in the United States: A Population-Based Contemporary Study From NHANES 2017- 2020
Authors: Wafa Nabi, Arya Aminorroaya, Rohan Khera
Journal: Circulation (2023)

Background: ACC/AHA guidelines recommend at least 75 and 150 minutes per week of moderate-intensity and vigorous-intensity activity respectively for improved glycemic, blood pressure, and lipid management in patients with diabetes, hypertension, and hypercholesterolemia, and improved long-term CV outcomes. This study aimed to investigate physical activity patterns in these patients with long-standing recommendation for achieving these optimal physical activity goals. Methods: We used publicly available NHANES 2017-2020 US Population Data to identify individuals with CV risk factors and their self-reported physical activity. Individuals were diagnosed with diabetes, hypertension, or hypercholesterolemia, based on standardized questionnaire focusing on diagnosis by clinician or receipt of relevant therapies for the treatment of these conditions. Results: Of 9693 surveyed adults with mean age of 47.5 (1.0) years, 1445 (14.9%) patients reported a medical history of diabetes. Of these cohort of diabetics, only 636 patients (46.4%) reported doing a sufficient amount of physical activity in adherence to ACC/AHA guidelines. Among patients diagnosed with hypertension (2784) and hypercholesterolemia (2007), only 1410 (50.6%) and 1020 (50.8%) respectively reported performing a sufficient amount of physical activity per guidelines. Conclusions: These results point to much room for improvement to optimize modifiable cardiovascular disease risk factors such as insufficient physical activity in patients who are already at increased CV disease risk due to history of diabetes, hypertension, and hypercholesterolemia. Next steps should involve heightened focus on counseling and lifestyle modification to reduce risk of cardiovascular disease.
Abstract P381: Factor VIII and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study
Authors: Eric Stoutenburg, Sarah Sherman, Maria Cristina Bravo, Virginia J Howard, Debora Kamin Mukaz, Mary Cushman, Neil Zakai, Suzanne E Judd, Tim B Plante
Journal: Circulation (2023)

Background: Black adults have a disproportionate hypertension burden. While some excess risk is mediated by diet and sociodemographics factors (e.g., income, education) much remains unexplained. Pro-thrombotic and pro-inflammatory states are associated with hypertension risk; higher coagulation factor VIII (FVIII) is associated with thrombosis, inflammation, and cardiovascular disease. Black adults have higher FVIII than White adults. We sought to estimate incident hypertension risk among Black and White REGARDS adults by FVIII level, and determine if FVIII mediates some of the excess hypertension burden in Black REGARDS participants. Methods: Hypertension was use of blood pressure (BP)-lowering medications or 140/90 mm Hg BP threshold. We included Black and White participants from REGARDS without Visit 1 (2003-2007) hypertension, and hypertension assessment at visit 2 (2013-2016), and Visit 1 ELISA-measured FVIII. Modified Poisson regression estimated risk ratios (RR) of incident hypertension by FVIII level in models controlling for known confounders, stratified by race given a significant race*FVIII interaction on incident hypertension. Inverse odds ratio weighting estimated % mediation of the Black-White hypertension risk in each model that was due to FVIII. Results: Among the 1,870 included participants, mean (SD) age was 62 (8), 51% were female and 36% were Black participants. Relative to White participants, Black participants had higher mean FVIII level (114% vs. 103%; P&lt;0.001) and 46% greater hypertension risk (95% CI 30-65%) in the crude model. Higher FVIII did not associate with greater hypertension risk in any model ( Figure ). Factor VIII did not mediate excess burden of hypertension among Black participants in any models. Conclusions: FVIII was not associated with greater hypertension risk and did not mediate any of the excess burden of incident hypertension seen among Black participants.